Rebellion21: The Pyretic Neonate – A Cautionary Tale for Decision-Making Rules via Hilary Fairbrother, MD

In this 16-minute presentation from Rebellion in EM 2021, Dr. Hilary Fairbrother, MD describes the Clinical Decision Rule formulated and validated in the PECARN network for fever in patients who are less than 60 days old. She reviews the rule and goes over the different elements of the patient that are required to use the rule. She concludes with a recent validation study that raises concerns on the initially reported accuracy of the rule and speaks briefly about the consequences of missed cases vs. procedural complications from neonatal sepsis workups.

Hilary Fairbrother, MD, MPH, FACEP
McGovern School of Medicine
University of Texas Health Houston
Department of Emergency Medicine
Vice Chair of Education
Houston, TX
Twitter: @hilaryfair


  1. Review the laboratory values needed to use the PECARN Clinical Decision Rule to identify neonates with serious SBI
  2. Discuss and review the recent validation study by Velasco et. Al
  3. Evaluate the PECARN Decision Rule for the febrile neonate



  1. Define the PECARN Clinical Decision rule to identify SBI in the febrile neonate
    1. Review different laboratory values necessary
    2. Give a clinical example
  2. Explain the Velasco validation study and its importance
    1. Is this validation study “valid?”
    2. How do their conclusions differ?
  3. Discuss what is an acceptable miss rate in the neonatal population
    1. Contrast to the complication rate of SBI rule out procedures
      1. LP
      2. Urine cath
      3. Phlebotomy
      4. Abx exposure
      5. Hospital stay
    2. In conclusion, is this CDR ready for widespread use?

Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)

Cite this article as: Salim Rezaie, "Rebellion21: The Pyretic Neonate – A Cautionary Tale for Decision-Making Rules via Hilary Fairbrother, MD", REBEL EM blog, September 18, 2021. Available at:
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Salim Rezaie

Emergency Physician at Greater San Antonio Emergency Physicians (GSEP)
Creator & Founder of REBEL EM

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